T Nation

Ulnar Nerve Surgery?

Hey guys,was wondering if any one has ever had ulnar nerve compression surgery ? or cubital surgery…
seems I need it done,any info would be great,and recovery…thanks guys

I am assuming that they would perform an ulnar nerve transposition. Has the doctor explained why they are opting for the surgery over an non-operative approach? How long has the issue with the ulnar nerve been going on?

I have worked with athletes who have had the ulnar nerve transposition and have continued on to successful athletic careers, one who is now pitching in the minor league. The recovery can take time though. Your forearm muscles will regain function quicker, but it will probably be several months before the forearm returns to full function. Your fine motor and small hand musculature will be the last to recovery and it can take up to 1-2 years for that, but that is on the long end. It is probably closer to an average of 10-14 months for those muscles to regain full function.

That was exactly what was recommended to me when I had cubital tunnel syndrome and loss of ulnar nerve function about 10 years ago.

However, I was afraid of having the surgery, and the surgeon did not offer a rational or evidence-based explanation of why the surgery would help, so I opted not to have the surgery.

[quote]LevelHeaded wrote:
I am assuming that they would perform an ulnar nerve transposition. Has the doctor explained why they are opting for the surgery over an non-operative approach? How long has the issue with the ulnar nerve been going on?

I have worked with athletes who have had the ulnar nerve transposition and have continued on to successful athletic careers, one who is now pitching in the minor league. The recovery can take time though. Your forearm muscles will regain function quicker, but it will probably be several months before the forearm returns to full function. Your fine motor and small hand musculature will be the last to recovery and it can take up to 1-2 years for that, but that is on the long end. It is probably closer to an average of 10-14 months for those muscles to regain full function. [/quote]

thank you for the reply, funny part is ,this seems to have come about after I hand carpal tunnel surgery on both wrists,but its bad,numb all the time,nothing else has worked,I’m worried about recovery,I’m a fighter,but I also read that if I wait to long to have it done,I could get permanent numbness and muscle weakness,do you agree ? this has been going on for a few months,and has gotten worse or at least not better at all,I have tried other things, I do not want the surgery,I read so many bad stories,I’d rather hold off,thank you for your reply

[quote]andersons wrote:
That was exactly what was recommended to me when I had cubital tunnel syndrome and loss of ulnar nerve function about 10 years ago.

However, I was afraid of having the surgery, and the surgeon did not offer a rational or evidence-based explanation of why the surgery would help, so I opted not to have the surgery. [/quote]

so you did not have it ? how did it turn out ??

Have you attempted some aggressive soft tissue manipulation for the forearm and upper arm musculature, along with improving flexibility of the tissues?

If the nerve gets damaged enough, then yes there can be long-lasting impairment. But again, it comes down to if the situation can be reversed and improved with a rehabilitative approach. I am personally of the general opinion of first attempting a conservative, non-surgical approach and if no improvement is met, then going for surgical intervention. But that also depends on what you are attempting to do at the point in time and the time frame around your situation.

I have seen some people fore-go surgery and take the rehab approach and been very successful in terms of having little to no recurrent issues. I have also seen people attempt the rehab approach and eventually end up having the surgery anyways, which could have been for a variety of reasons - non-compliance to rehab protocols, frustration with slow progress of rehab, or the damage was too great to be fixed with rehab. The same has occurred with the surgical approach - I’ve seen people come back after surgery just as good, if not better than before. I’ve also seen people struggle heavily after surgery. I know that this past section hasn’t really helped you out in making your decision, so I guess the take home point is that you can’t rely on anybody else to make that decision for you, but instead just take all of the opinions as a whole and figure out which you feel works best in your situation.

Also, I would recommend reading up on Eric Cressey’s Understanding Elbow Pain series on his blog. There is a little talk about ulnar nerve, but a lot of discussion regarding preventative and restoration work on the surrounding soft tissue, along with some great anatomy information. Here is a link to Part 6 of the series, which has links to Parts 1-5. http://ericcressey.com/understanding-elbow-pain-part-6-elbow-pain-in-lifters

Hope this helps!

[quote]LevelHeaded wrote:
Have you attempted some aggressive soft tissue manipulation for the forearm and upper arm musculature, along with improving flexibility of the tissues?

If the nerve gets damaged enough, then yes there can be long-lasting impairment. But again, it comes down to if the situation can be reversed and improved with a rehabilitative approach. I am personally of the general opinion of first attempting a conservative, non-surgical approach and if no improvement is met, then going for surgical intervention. But that also depends on what you are attempting to do at the point in time and the time frame around your situation.

I have seen some people fore-go surgery and take the rehab approach and been very successful in terms of having little to no recurrent issues. I have also seen people attempt the rehab approach and eventually end up having the surgery anyways, which could have been for a variety of reasons - non-compliance to rehab protocols, frustration with slow progress of rehab, or the damage was too great to be fixed with rehab. The same has occurred with the surgical approach - I’ve seen people come back after surgery just as good, if not better than before. I’ve also seen people struggle heavily after surgery. I know that this past section hasn’t really helped you out in making your decision, so I guess the take home point is that you can’t rely on anybody else to make that decision for you, but instead just take all of the opinions as a whole and figure out which you feel works best in your situation.

Also, I would recommend reading up on Eric Cressey’s Understanding Elbow Pain series on his blog. There is a little talk about ulnar nerve, but a lot of discussion regarding preventative and restoration work on the surrounding soft tissue, along with some great anatomy information. Here is a link to Part 6 of the series, which has links to Parts 1-5. http://ericcressey.com/understanding-elbow-pain-part-6-elbow-pain-in-lifters

Hope this helps![/quote]

I thank you for your reply ,in researching for days, it seems split 50% turn out good…50% not so good…and the recovery times are all over the place,some ortho sites says 6 months…some say 6-18 months,and yes you have been helpful and just taking the time is help enough,heres a better idea of my story…I cant real afford to have a lot of recovery time,and being a puncher,will it come back 100%,or Im thinking have it fixed in a year maybe,but I’m afraid of perm damage,If your aware of any of the test,if I just bend my arms towards my chest,the numbness starts in less then 10 seconds,and if I even touch my elbow,instant numbness,I thought i read once before being on TESTOSTERONE could cause wrist probs?? who knows,im on TRT,and do you think having carpal tunnel surgery has anything to do wit it ? thanks so much…Im going to read that link now…

If just palpation has caused that amount of sensitivity, your nerve already sounds pretty heavily inflamed. If anything, I would look into talking to your doctor about an anti-inflammatory Rx to try and settle down the nerve (prednisone/medrol dose pack, etc) along with the soft tissue and mobility work.

Did you get an MRI or nerve conductance tests done on your forearm/elbow? When was the carpal tunnel surgery? Did you have an open release CT surgery or an endoscopic surgery? This is complete assumption since I can’t physically see/assess you, but there may be some heavy restrictions in your wrist/forearm muscles depending on how your CT surgeries went. Were you splinted after the surgery? Limited in movement, motion, and activities?

I completely understand that you can’t afford a lot of recovery time/time off as I work with and know several MMA fighters. If you take too much time off, you may miss your shot. But you also have to look at it as if you can’t perform at your best, what good are you doing for your career as well.

I would definitely discuss things with your doctors and determine your options. Let them be aware of your goals and current activities so they will have a better understanding of your frame of mind.

[quote]fightu35 wrote:

[quote]andersons wrote:
That was exactly what was recommended to me when I had cubital tunnel syndrome and loss of ulnar nerve function about 10 years ago.

However, I was afraid of having the surgery, and the surgeon did not offer a rational or evidence-based explanation of why the surgery would help, so I opted not to have the surgery. [/quote]

so you did not have it ? how did it turn out ??[/quote]
I’m fine now. I did rehab every day, improved my work ergonomics, and wore a brace at night to keep my elbow neutral. It took several months before I saw improvement. I couldn’t even move three of my fingers at the time, but recovered completely.

I have read all the scary stuff about the permanence of nerve damage, and I’m sure there is a type of damage that IS permanent, but I guess they can’t tell that from a nerve conductance test.

[quote]LevelHeaded wrote:
If just palpation has caused that amount of sensitivity, your nerve already sounds pretty heavily inflamed. If anything, I would look into talking to your doctor about an anti-inflammatory Rx to try and settle down the nerve (prednisone/medrol dose pack, etc) along with the soft tissue and mobility work.

Did you get an MRI or nerve conductance tests done on your forearm/elbow? When was the carpal tunnel surgery? Did you have an open release CT surgery or an endoscopic surgery? This is complete assumption since I can’t physically see/assess you, but there may be some heavy restrictions in your wrist/forearm muscles depending on how your CT surgeries went. Were you splinted after the surgery? Limited in movement, motion, and activities?

I completely understand that you can’t afford a lot of recovery time/time off as I work with and know several MMA fighters. If you take too much time off, you may miss your shot. But you also have to look at it as if you can’t perform at your best, what good are you doing for your career as well.

I would definitely discuss things with your doctors and determine your options. Let them be aware of your goals and current activities so they will have a better understanding of your frame of mind.[/quote]

what is palpattion? the bent arm test I did ?Ok,no MRI,or anything on elbow,just x-ray,I had nerve conduction test,and a EMG I think its called,but those where months ago,and it has gotten worse.
I had open release,and to be honest,I used my hands prob a lil to fast,and not really hand a splint,and would not wear it do bed…Im a cement head I guess,so you think it might have something to do with the CT ?.he knows what I do,and want,he has been my Dr for over 10 yrs,and saved my hand with the screw operation…(screw in right hand) And he gave me an injection up on the inside of my arm near elbow,it worked for about 3 days…Do you think my nerve is far enough damaged to need surgery ? thank you very much for the help.

Palpation is when the doc or whoever just touches and feels around an area with their hands.

Did you get anything done besides just the injection at your elbow? Any rehab, soft tissue work, etc? Or was it just “here is the shot it will make you feel better”?

With the CT surgery, I’m not saying that the surgery itself had something to do with it. More that any alterations in your movement and activity of your wrist may have lead to a muscular imbalance which could have caused restriction and impingement of your ulnar nerve. Again, this is all speculation as I can’t see/eval you in person. But it is sounded pretty serve. I would schedule a follow up with your doc to see what the next step it.

Rest helped mine.

[quote]LevelHeaded wrote:
Palpation is when the doc or whoever just touches and feels around an area with their hands.

Did you get anything done besides just the injection at your elbow? Any rehab, soft tissue work, etc? Or was it just “here is the shot it will make you feel better”?

With the CT surgery, I’m not saying that the surgery itself had something to do with it. More that any alterations in your movement and activity of your wrist may have lead to a muscular imbalance which could have caused restriction and impingement of your ulnar nerve. Again, this is all speculation as I can’t see/eval you in person. But it is sounded pretty serve. I would schedule a follow up with your doc to see what the next step it.[/quote]

a lil rehab yes,but nothing great,no soft tissue work,and he does not like to just keep giving injections,next step is surgery he said…ive yet to call n book it,told him I d let him know,not sure if this matters my forearms are pretty big,and they are strong,no probs,there,at this point Im calling my team,then I’ll decide whether to fight in Aug or not,that’s a lot for the help.
not to bug you,but do you know anything about SLAP tear ? feel free to not answer,you have given me plenty of ya time…

What did you want to know? You having shoulder pain?

[quote]LevelHeaded wrote:
What did you want to know? You having shoulder pain?[/quote]
well just figured I would ask,you seem know what ya talking about,I also have a slap tear,the labrum/,im doing great aren’t I ,lol the oddest thing,hurt like wow !! for 5 days…could not move…
now its pretty much pain free,stiff in a few motion,but its been 2 weeks…got 1 shot in it…hes not an expert on shoulders,(hands,wrist) I can punch fine,cant throw a baseball though…,10 yrs ago had labrum repair some shoulder and 2 anchors put in,he said those where intact,so this is in a different spot…

Do you recall where the tear was and anchors were put from the 1st surgery? Have you gotten a recent MRI on your shoulder? Is the shoulder the same arm as the elbow?

Depending on the severity of the tear, you can take a non-operative approach with rehab and can normally be fully functional depending on your activity. If you were a baseball player with a SLAP tear, more than likely, surgery would be the best option due to the nature of the sport. With MMA, as long as there isn’t a significant tear, the pain is tolerable, and there isn’t gross instability to your glenohumeral joint, you can definitely take a conservative/rehab approach. Just don’t expect to play on any summer softball beer leagues.

[quote]LevelHeaded wrote:
Do you recall where the tear was and anchors were put from the 1st surgery? Have you gotten a recent MRI on your shoulder? Is the shoulder the same arm as the elbow?

Depending on the severity of the tear, you can take a non-operative approach with rehab and can normally be fully functional depending on your activity. If you were a baseball player with a SLAP tear, more than likely, surgery would be the best option due to the nature of the sport. With MMA, as long as there isn’t a significant tear, the pain is tolerable, and there isn’t gross instability to your glenohumeral joint, you can definitely take a conservative/rehab approach. Just don’t expect to play on any summer softball beer leagues. [/quote]

its the same shoulder,anchors are fine,and its in a different place…I can punch fine, cant scratch my own back to well though,which is not important,I know 1 thing labrum repair hurtttt, long rehab with the new injury yes MRI,the biceps head in intact, its not an issue so far,but is it something that would need to be fixed ? or just leave it ?

Thats a call for you and your doctor. It all comes down to severity of injury, etc. If you do need a repair, you mine as well get the ulnar done at the same time if possible.

[quote]LevelHeaded wrote:
Thats a call for you and your doctor. It all comes down to severity of injury, etc. If you do need a repair, you mine as well get the ulnar done at the same time if possible.[/quote]
thanks for all ya help…so the SLAP tear not have to always be repaired ?

Has anyone checked neck? Bilateral carpal tunnel, if that really was your problem, is pretty rare, and now you’re having ulnar nerve symptoms on one side? I’m surprised it hasn’t been checked given your history. If it has and its clean, try some soft tissue treatment (Active Release Technique, Graston/SASTM/Gua Sha) from a quality provider and if that doesn’t clean it out, think about surgery.